Mammalian cathepsins are cysteine-type proteases involved in key steps of biological and pathological events. Cathepsins are considered tractable drug targets as it is feasible to inhibit enzymatic activity with small molecules and are therefore of interest to the pharmaceutical industry (Bromme, D. (2001), ‘Papain-like cysteine proteases’, Curr Protoc Protein Sci, Chapter 21, Unit 21 2; Roberts, R. (2005), ‘Lysosomal cysteine proteases: structure, function and inhibition of cathepsins’, Drug News Perspect, 18 (10), 605-14).
Cathepsin S is prominently expressed in antigen presenting cells like macrophages and dendritic cells and smooth muscle cells. (Hsing, L. C. and Rudensky, A. Y. (2005), ‘The lysosomal cysteine proteases in MHC class II antigen presentation’, Immunol Rev, 207, 229-41; Rudensky, A. and Beers, C. (2006), ‘Lysosomal cysteine proteases and antigen presentation’, Ernst Schering Res Found Workshop, (56), 81-95). While Cathepsin S is only weakly expressed in normal arterial tissue, strong upregulation is seen in atherosclerotic arteries (Liu, J., et al. (2006), ‘Increased serum cathepsin S in patients with atherosclerosis and diabetes’, Atherosclerosis, 186 (2), 411-9; Sukhova, G. K., et al. (1998), ‘Expression of the elastolytic cathepsins S and K in human atheroma and regulation of their production in smooth muscle cells’, J Clin Invest, 102 (3), 576-83).
Preclinical data suggest that the function of Cathepsin S is critical for atherosclerosis as Cathepsin S deficient mice have a reduced atherosclerosis-phenotype when tested in appropriate mouse models. In LDL-Rec deficient mice reduced lipid accumulation, elastin-fibre breakdown and chronic arterial inflammation is reported. In APO E deficient mice a significant reduction of acute plaque rupture events was reported. When chronic renal disease is introduced into CatS/In APO-E deficient mice a strong reduction of accelerated calcification is seen on top of the anti atherosclerotic activity in arteries and heart valves (Aikawa, E., et al. (2009), ‘Arterial and aortic valve calcification abolished by elastolytic cathepsin S deficiency in chronic renal disease’, Circulation, 119 (13), 1785-94; de Nooijer, R., et al. (2009), ‘Leukocyte cathepsin S is a potent regulator of both cell and matrix turnover in advanced atherosclerosis’, Arterioscler Thromb Vasc Biol, 29 (2), 188-94; Rodgers, K. J., et al. (2006), ‘Destabilizing role of cathepsin S in murine atherosclerotic plaques’, Arterioscler Thromb Vasc Biol, 26 (4), 851-6; Sukhova, G. K., et al. (2003), ‘Deficiency of cathepsin S reduces atherosclerosis in LDL receptor-deficient mice’, J Clin Invest, 111 (6), 897-906). This suggests a potential inhibitor of Cathepsin S would stabilise atherosclerotic plaque by reducing extracellular matrix breakdown, by reducing the proinflammatory state and by reducing accelerated calcification and subsequently its clinical manifestations.
These phenotypes described in atherosclerosis models are in agreement with known cellular functions of Cathepsin S. Firstly, Cathepsin S is involved in the degradation of extracellular matrix that stabilises the plaque. In particular, Cathepsin S has potent elastinolytic activity and can exert this at neutral pH, a feature that distinguishes Cathepsin S from all other Cathepsins. Secondly, Cathepsin S is the major protease involved in antigen processing, in particular cleavage of the invariant chain in antigen presenting cells, resulting in reduced contribution of Tcells to the chronic inflammation of the atherosclerotic tissue. Elevated inflammation results in further oxidative and proteolytic tissue damage and subsequently plaque destabilisation (Cheng, X. W., et al. (2004), ‘Increased expression of elastolytic cysteine proteases, cathepsins S and K, in the neointima of balloon-injured rat carotid arteries’, Am J Pathol, 164 (1), 243-51; Driessen, C., et al. (1999), ‘Cathepsin S controls the trafficking and maturation of MHC class II molecules in dendritic cells’, J Cell Biol, 147 (4), 775-90; Rudensky, A. and Beers, C. (2006), ‘Lysosomal cysteine proteases and antigen presentation’, Ernst Schering Res Found Workshop, (56), 81-95).
The anti-inflammatory and anti-elastinolytic properties of a Cat S inhibitor make it also a prominent target for chronic obstructive pulmonary disease (Williams, A. S., et al. (2009), ‘Role of cathepsin S in ozone-induced airway hyperresponsiveness and inflammation’, Pulm Pharmacol Ther, 22 (1), 27-32). Furthermore due to its extracellular functions in matrix degradation, inhibition of cathepsin S will impact neointima formation and angiogenesis (Burns-Kurtis, C. L., et al. (2004), ‘Cathepsin S expression is up-regulated following balloon angioplasty in the hypercholesterolemic rabbit’, Cardiovasc Res, 62 (3), 610-20; Cheng, X. W., et al. (2004), ‘Increased expression of elastolytic cysteine proteases, cathepsins S and K, in the neointima of balloon-injured rat carotid arteries’, Am J Pathol, 164 (1), 243-51; Shi, G. P., et al. (2003), ‘Deficiency of the cysteine protease cathepsin S impairs microvessel growth’, Circ Res, 92 (5), 493-500; Wang, B., et al. (2006), ‘Cathepsin S controls angiogenesis and tumor growth via matrix-derived angiogenic factors’, J Biol Chem, 281 (9), 6020-9). An inhibitor of Cathepsin S might therefore be useful in several different disease settings.
Cathepsin S plays also a role in the reduction of tumor growth and tumor cell invasion as described by Roberta E. Burden in Clin Cancer Res 2009; 15(19). In addition, nephrectomized Cathepsin S knock out mice showed a significant reduction of arterial calcification when compared to nephrectomized wild type mice. This indicates that inhibition of Cathepsin S may have a beneficial effect on the reduction of cardiovascular events in chronic kidney disease patients (Elena Aikawa, Circulation, 2009, 1785-1794).